WASHINGTON – The calls went out to a dozen randomly chosen health care facilities in the Twin Cities area. Staff members of the U.S. Government Accountability Office posed as patients who asked for the cost of common hernia repairs or colonoscopies.

Half of them could not get answers.

Those who received responses got price quotes that in some cases were three times higher than the competition with no quality measures to justify the higher charge.

"We were trying to put on the face of a consumer," said Linda Kohn, who directs the GAO's health care team. "The takeaway is that it is pretty hard to get this information."

The government watchdog agency tested the availability of health care cost and quality data in several areas across the country. It picked Minnesota and Oregon specifically because both states have programs in place that are supposed to make it simple for patients to find good, affordable service as they choose between caregivers.

Minnesota also has a law that "requires providers to make estimated costs of treatment and estimated costs that must be paid by the patient available upon request," GAO pointed out in a report released last week.

The report said that "initiatives to promote transparency" in Minnesota and Oregon did not guarantee cost and quality information. Of the 24 providers GAO contacted in both states, only 13 provided "limited" cost information and just seven provided quality data for hernia repairs and diagnostic colonoscopies for an uninsured patient. Of the 13 giving cost information, just five "were able to estimate … all of the facility, physician, anesthesia and other costs involved," the report said.

"Our experiences receiving limited cost and quality information in two locations that have adopted specific initiatives to promote cost and quality transparency … suggest that consumers in other locations would face similar difficulties when calling providers," the GAO concluded.

Kohn declined to name the Minnesota ambulatory surgery centers and outpatient facilities that were surveyed.

Four U.S. senators, including Minnesota Democrat Amy Klobuchar, requested the GAO study. It recommends specific changes to the federal Centers for Medicare & Medicaid Services (CMS) website to which most states, including Minnesota, often direct consumers for comparative health care data.

"Empowering consumers with accurate information about their health care options is a win-win," Klobuchar said in an e-mail to the Star Tribune. "It helps cut costs for patients while improving our health care system across the board. That's why I requested this report, and its findings make clear there is more work to do."

As the GAO struggled to get accessible, understandable information at the state level, the agency identified what it called "critical weaknesses" in the CMS website. The federal site should include ways for individuals to estimate out-of-pocket costs for common medical procedures, the report said, and CMS should also organize cost and quality data in a way that lists top performing providers first.

Minnesota organizations in charge of informing health care consumers defended their programs, which are some of the nation's most extensive. They challenged the GAO decision to call providers directly to ask for cost and quality information about specific procedures.

"It's not representative of how most people are shopping," said Wendy Burt, communications director for the Minnesota Hospital Association.

In 2007, the state Legislature passed a law requiring hospital pricing to be made public. As part of the law, the hospital association gathers cost information and displays it on a website called Minnesota Hospital Price Check. But the site only provides a general comparison of facilities, Burt said. For specifics, individuals must still contact their health insurance companies for costs that have been negotiated for their specific policies.

MN Community Measurement, a nonprofit set up in 2004 to improve health care in the state by making health information public, just "revamped" its website, mnhealthscores.org, "to make it more consumer-friendly," said Tina Frontera, MN Community Measurement's chief operating officer.

New cost-comparison data is being finalized for publication on the website beginning in January, Frontera said. She declined to elaborate.

The site now ranks care providers by performance for 14 common treatment areas. Ratings range from "Top" to "Below Average" based on "best practices, community consensus and national standards," Frontera said.

"The GAO report highlights why an organization like ours is important," she added.

The clinics the GAO called probably could not answer questions about cost and quality of specific procedures because, according to Frontera, "front line staff aren't armed with training to provide that information."

At the same time, Minnesota law requires health care providers and hospitals — or their "designees" — to provide "good faith" estimates of the costs of procedures to patients who request them. The costs are supposed to include out-of-pocket charges to patients, as well as charges to health insurers.

While the law is on the books, no one appears responsible for enforcing it. The Minnesota attorney general's office said it was the responsibility of the state Health Department. But Diane Rydrych, the Health Department's policy director, said the agency has no "explicit" enforcement authority outside of the ability to tell hospitals that they must disclose general pricing figures to the Minnesota Hospital Association if they refuse to do so.

As far as guaranteeing the law's promise that consumers can get medical cost and quality information from health care providers on request, as the GAO tried, Rydrych said, "the assumption was it would happen."

If it isn't happening, she continued, "the legislature would have to consider whether they want to look at a different approach that has more of a regulatory flavor."